What to look for in a health insurance policy

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People who work in corporates often have a health insurance policy provided by their employers. While this is good, the rising medical costs mean that such policies are often not enough to cover all eventualities. That is why most people also take a separate health insurance policy over and above their corporate cover, if any. Self-employed people anyway need to plan for their medical insurance by themselves. So whether employed or self-employed, it is important to have a good understanding of medical insurance policies so that you can choose the one that gives you the best protection at the most reasonable rates.

1. Location : By definition, a particular health insurance policy should be uniform across the country, irrespective of which location it has been taken from. For example, if a person has taken a particular health insurance policy at Mumbai, it should have the same terms and conditions as another person who has taken the same policy at Coimbatore. But often, the coverage provided by the same policy is different in different cities. You need to be aware of such discrepancies, if any, and take the policy only if it is uniform across locations. This is also important for you to check if you have a transferable job, so that the terms of the policy do not change when you relocate.

2. Types of Medication : A growing number of people are shying away from the usual treatment nowadays because of several factors like lower faith on quality of doctors, possibility of wrong or fake medicines being provided, age and physical condition of the patient etc. This has given rise to a growing tendency to avail alternative treatment methodologies like Unani, Homoeopathy, Ayurveda and so on. But most health insurance policies do not cover this kind of treatment. If you think that your family or you might lean towards such alternative therapies in future, then it is prudent to check with your insurer if the cost of such treatments is covered.

3. Exclusions – This is one of the most important reasons why you should read the fine print of a health insurance policy. Every insurance policy clearly specifies certain illnesses that wouldn’t be covered and certain parts of expenses that wouldn’t be covered. For example, a policy might cover cataract surgery expenses but not expenses for spectacles. Again, declared illnesses often begin to get coverage only after a certain period like six months or three years from the date of the issuance of the policy. For example, if you have diabetes, then expenses related to diabetes would get coverage only from the third year of the policy. Depending on the health conditions of the people who are sought to be covered, you need to choose the correct policy.

4. Specific Charges – There are policies which cover surgical or in-patient (admitted patient) charges, but do not cover outpatient charges. But if you are likely to spend more on OPD consultation but not very likely to get admitted or have a surgical procedure, then you should look for a policy in which OPD is also covered. Even when you get admitted or have a surgical procedure, the cost of several items (consumables like gloves and syringes, for instance) is often not included in the coverage. If a particular policy has a very low premium amount, then it is a good idea to find out about such things so that you don’t end up actually spending a lot of money from your pocket in spite of having a health insurance policy.

5. Rewards – Most health insurers design their products in such a way that the majority of healthy people who do not claim at all subsidise those people who make a claim. If you are someone who is likely to have claim free years initially, then you should find out the rewards you are eligible for if you do not have any claim in a year.